Time for action

Mental Health Nursing,  Jan 2003  by Rushforth, David

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The announcement of a major drive to tackle the parlous state of mental health nursing recruitment is a belated, but welcome initiative. The chorus of 'not before time' echoes throughout the mental health sector, but is loudest of all in acute care.

Coincidentally, a two year long review of skills and career progression across the NHS reported the same week. In mental health acute care the success will be judged on one criteria; the retention of nursing staff in ward-based areas - which means improved promotional opportunities.

The trends have been stark. Over 20 years we have seen a rapid decrease in in-patient beds, down to 42,000. The gradual diversion of resources to community mental health and admission prevention services, (commendable from the user perspective) has inadvertently asset stripped in-patient services of seasoned mental health nurses. The end result is predictable: acute wards are understaffed, relatively inexperienced and often heavily reliant on agency nurses.

The challenges are formidable. Recent DOH figures confirmed a 40 percent increase in applications for Section 2, 3 and 4 orders since 1992. In itself, this poses significant challenges in balancing legal rights, assertive treatment and personal safety.

Secondly, witness the changing profile of in-patients. Heavy drug use, most notably of cannabis and cocaine are implicated in the increased vulnerability to psychosis. The implications for the personal safety of both users and staff are self-evident.

Recent reports on acute care by the Sainsbury Centre and the Department of Health catalogue poor standards of care and staff. The recommendations are constructive, but they will remain merely worthy, unless the resources are forthcoming.

Immediate action is also needed to stave off the mounting crisis in accommodation. There is a significant shortage of local, affordable and safe housing for people who are due for discharge from hospital. So please can we have an end to the pillorying of bed managers. There is a systemic nationwide problem of affordable housing and it is not bed managers' job to solve this crisis outwith the NHS.

The introduction of fines for bed blocking is an act of monumental folly and risks management expediency over-ruling clinical judgement in the crudest and most punitive of fashions. This will produce losers all round: patients discharged into unsuitable accommodation, painstaking rehabilitation undone, unit services out of pocket and auditors acting as car park attendants.

'Joined-up-thinking' surely recognises that the NHS does not operate in a vacuum. The priority need is for significant new investment in non-statutory organisations with a track record of addressing this most fundamental of human needs.

Mental health and social care trusts desperately need the resources to deliver on both fronts, in order to improve the recruitment and retention of staff to in-patient services and for investment in the social care infrastructure. Without this the pressure on ward areas will remain unrelenting. MHN

Copyright Community Psychiatric Nurses Association Jan 2003
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